Abstract

Background

Effective teaching requires an understanding of both what (content knowledge) and how (process knowledge) to teach. While previous studies involving medical students have
compared preceptors with greater or lesser content knowledge, it is unclear whether
process expertise can compensate for deficient content expertise. Therefore, the objective
of our study was to compare the effect of preceptors with process expertise to those
with content expertise on medical students' learning outcomes in a structured small
group environment.

Methods

One hundred and fifty-one first year medical students were randomized to 11 groups
for the small group component of the Cardiovascular-Respiratory course at the University
of Calgary. Each group was then block randomized to one of three streams for the entire
course: tutoring exclusively by physicians with content expertise (n = 5), tutoring
exclusively by physicians with process expertise (n = 3), and tutoring by content
experts for 11 sessions and process experts for 10 sessions (n = 3). After each of
the 21 small group sessions, students evaluated their preceptors' teaching with a
standardized instrument. Students' knowledge acquisition was assessed by an end-of-course
multiple choice (EOC-MCQ) examination.

Results

Students rated the process experts significantly higher on each of the instrument's
15 items, including the overall rating. Students' mean score (±SD) on the EOC-MCQ
exam was 76.1% (8.1) for groups taught by content experts, 78.2% (7.8) for the combination
group and 79.5% (9.2) for process expert groups (p = 0.11). By linear regression student
performance was higher if they had been taught by process experts (regression coefficient
2.7 [0.1, 5.4], p < .05), but not content experts (p = .09).

Conclusions

When preceptors are physicians, content expertise is not a prerequisite to teach first
year medical students within a structured small group environment; preceptors with
process expertise result in at least equivalent, if not superior, student outcomes
in this setting.